Showing papers in "Journal of Nursing Management in 2019"

Push and pull factors of nurses' intention to leave.

Abstract: Aim Expand knowledge about the predictive factors of nurses’ intention to leave their job, and consequently to turnover. Background Nurse turnover is costly and negatively influences quality of care. Understanding the association between intention to leave and modifiable features of hospital organization may inform strategies to reduce turnover. Methods A cross-sectional survey of 3667 medical and surgical nurses was conducted in Italy. Measures included intention to leave; work environment; burnout; job satisfaction and missed care using the RN4CAST instruments. Descriptive, logistic regression analysis was used. Results Due to job dissatisfaction, 35.5% of the nurses intended to leave their current job, and of these, 33.1% the nursing profession. Push factors included: understaffing, emotional exhaustion, poor patient safety, performing non-nursing care, being male. Pull factors included: positive perception of quality and safety of care, performing core nursing activities. Conclusion The present study expands knowledge about the predictive factors of nurses’ intention to leave their job, and consequently to turnover, which is one of today’s major issues contributing to the shortage of nurses. Implications for Nursing Management Nurses’ intention to leave their job is the consequence of a poor work environment, characterized by factors such as understaffing and performance of non-nursing activities.

Nurse leaders’ strategies to foster nurse resilience

Abstract: Aim To identify nurse leaders' strategies to cultivate nurse resilience. Background High nursing turnover rates and nursing shortages are prominent phenomena in health care. Finding ways to promote nurse resilience and reduce nurse burnout is imperative for nursing leaders. Methods This is a qualitative descriptive study that occurred from November 2017 to June 2018. This study explored strategies to foster nurse resilience from nurse leaders who in this study were defined as charge nurses, nurse managers and nurse executives of a tertiary hospital in the United States. A purposive sampling method was used to have recruited 20 nurse leaders. Results Seven strategies are identified to cultivate nurse resilience: facilitating social connections, promoting positivity, capitalizing on nurses' strengths, nurturing nurses' growth, encouraging nurses' self-care, fostering mindfulness practice and conveying altruism. Conclusions Fostering nurse resilience is an ongoing effort. Nurse leaders are instrumental in building a resilient nursing workforce. The strategies identified to foster nurse resilience will not only impact the nursing staff but also improve patient outcomes. Implications for nursing management The strategies presented are simple and can be easily implemented in any settings. Nurse leaders have an obligation to model and enable evidence-based strategies to promote nurses' resilience.

Relationship between authentic leadership and nurses' intent to leave: The mediating role of work environment and burnout

Abstract: Aim The aim of this study was to explore the mediating effects of work environment and burnout on the relationship between authentic leadership and the intention of nurses to leave their job Background Authentic leadership can contribute to a good work environment Burnout is a critical factor that affects nurses‧ intent to leave The mediating roles of work environment and burnout on the relationship between authentic leadership and intent to leave is unclear Methods A cross-sectional design was used, and 946 nurses from three different levels of hospital (medical center, regional, and district), defined in terms of the number of beds and type of medical care provided, responded to four self-report questionnaires Results Work environment and burnout mediated the effect of authentic leadership on intent to leave among nurses The mediating effects of burnout on authentic leadership was present both for junior (β = 0073) and senior (β = 0081) nurses Conclusion Authentic leadership can affect nurses‧ intent to leave but the work environment and burnout are important mediators of this influence Implications for nursing management Administrators should adopt authentic leadership practices and make efforts to improve the work environment and decrease burnout in order to decrease nurses‧ intent to leave

Determinants of nurse absenteeism and intent to leave: An international study.

Abstract: Aim: To determine factors associated with nurses’ intent to leave their positions and absenteeism Background: There is a recognized global shortage of nurses but limited data describing and determining factors associated with nurse absenteeism and intent to leave Methods: This study involved a secondary analysis of the results from direct-care registered nurses’ responses to the MISSCARE Survey, with data from seven countries included Multi-level modelling was used to determine nurse characteristics and working environment factors associated with nurse absenteeism and intent to leave Results: The level of absenteeism and intent to leave varied significantly across countries, with registered nurses in Lebanon reporting the highest intention to leave within 12 months (43%) and registered nurses in Iceland and Australia the highest level of absenteeism (74% and 73%, respectively) Factors associated with outcomes included perceived staffing adequacy of unit, job satisfaction, and age of the nurse Conclusions: A significant difference between countries was identified in nurse absenteeism and intent to leave Increased perception of unit staffing inadequacy, lower job satisfaction, less nurse experience, and younger age were significant contributors to nurse absenteeism and intent to leave Implications for Nursing Management: These findings suggest that regardless of country and hospital, by ensuring that units are adequately staffed and increasing job satisfaction, younger, less experienced nurses can be retained and absenteeism reduced

Work stress, perceived social support, self-efficacy and burnout among Chinese registered nurses

Abstract: Aims To establish a model and identify structural relationships between Chinese nurses' perceived social support, self-efficacy, work stress and burnout. Background The prevalence of burnout among nurses tends to be high worldwide. A better understanding of relationships between the study variables can help hospital managers apply effective programmes to reduce burnout. However, no studies have identified the structural relationships between these variables in one model, simultaneously. Methods We conducted a cross-sectional survey to complete questionnaires from 444 nurses working in three Chinese general tertiary hospitals. The proposed model was examined by structural equation modelling. Results The proposed model was partially supported by empirical data. The total effect of work stress on burnout was large. Both work stress and the perceived social support moderately and directly affected burnout. Work stress also indirectly affected burnout through perceived social support. Work stress directly influenced perceived social support and self-efficacy. Perceived social support directly affected self-efficacy. However, self-efficacy did not directly influence burnout. Conclusions This study validated a model and identified a deep understanding of structural relationships between the selected variables among Chinese nurses. Implications for nursing management Apart from reducing work stressors, hospital managers should utilize more social support strategies when designing intervention programmes to reduce burnout.

Protecting emergency room nurses from burnout: The role of dispositional mindfulness, emotion regulation and empathy.

Abstract: Aim To verify the role of dispositional mindfulness, difficulties in emotion regulation and empathy in explaining burnout levels of emergency room (ER) nurses. Background Many studies have examined the variables that can affect burnout amongst ER nurses, but little is known about factors that can protect ER nurses against work-related stress. Method A multi-centre cross-sectional design was used. Burnout level intensity, dispositional mindfulness facets, difficulties in emotion regulation and empathy dimensions were assessed using valid and reliable self-report questionnaires in a sample of ER nurses (N = 97) from three different hospitals. Results Higher dispositional mindfulness and cognitive empathy levels and lower difficulties in emotion regulation, were negatively associated with emotional exhaustion levels. Conclusion ER nurses with more mindful, emotion regulation and empathy skills are more able to manage work-related distress. Implications for nursing management Experiential interventions to promote mindfulness skills, emotion regulation variability and flexibility in a clinical context and the cognitive side of empathy are recommended for ER nurses to reduce professional distress, and to enhance personal and work satisfaction. Future research should assess the effectiveness of new multi-factorial interventions which combine the development of mindfulness, emotion regulation and empathy skills in ER nurses.

Correlation between nursing managers' leadership styles and nurses' job stress and anticipated turnover.

Abstract: Aim To investigate the relationship between leadership style with nurse job stress and anticipated turnover. Background An appropriate leadership style should promote the efficacy of nurses. Different leadership styles can affect nurse's job stress and the numbers of nurses leaving their workplace or their profession. Methods In this cross-sectional correlational study, 1,617 nurses were selected from the governmental hospitals in Iran 2016-2017. Data were analyzed using descriptive and inferential statistics in SPSS20 . Results Nursing Manager's leadership style was transactional leadership. Both transformational and transactional leadership style have a significant relationship with job stress and anticipate staff turnover. A positive relationship was found between a laissez-faire leadership style with job stress and anticipated turnover. Conclusion The transformational and transactional leadership styles can reduce nurse's job stress and intention to leave, so nurse leaders can use combination of transformational and transactional leadership for improving job satisfaction and quality of nursing services. Implications for nursing management Leaders should emphasize a clear expression of values, objectives, and mission of the organisation; and try to raise confidence in employees, respecting and caring for them, supporting their views and suggestions, and being optimistic about the future.

Sleep problems in shift nurses: A brief review and recommendations at both individual and institutional levels

Abstract: Aims The purposes of this article are (a) to review briefly the current literature on shift nurses' sleep patterns, sleep quality, and the existing interventions implemented in nursing settings; and (b) to propose solutions that target individual nurses, nurse managers, and health care organisations to improve sleep health in shift nurses Background Sleep problems among shift nurses have been recognized increasingly as a significant issue at both the individual and organisational levels However, the solutions are not well known Design Narrative review Methods A literature search was conducted using the following databases: CINAHL, PubMed, Embase, and Google Scholar from 1986 to 2016, to include original papers that reported studies on shift nurses' sleep problems and interventions Results Thirteen papers were included in this review, which all indicated associations between shift nurses' sleep problems and current intervention practices Despite the higher prevalence of sleep problems in shift nurses compared to the general population, current interventional practices only focus on bright-light exposure, nap breaks, shift schedule rearrangement, and behavioural interventions Conclusions To address shift nurses' poor sleep quality, we proposed two levels of approach for consideration-the individual level and the management/institutional level The recommendations include: improving sleep hygiene; providing a low-stimulation sleep environment; conducting rigorous intervention studies to evaluate the effectiveness of a variety of therapies to deal with shift nurses' sleep disturbances; increasing awareness of sleep health of shift nurses; establishing a flexible rotating work schedule; and putting in place policies such as a 15-30 min nap break, social support, and a suitable working environment Implications for nursing management With better awareness and understanding of shift nurses' sleep behaviours, effective interventions can be employed to improve shift nurses' sleep patterns and sleep quality to promote better emotional and health outcomes

Resilience in nursing: The role of internal and external factors.

Abstract: Recent evidence shows that resilience can buffer the negative impact of workplace stressors on nurses and is linked to favourable patient outcomes. However, the comparative effectiveness of different contributing factors to nurses' resilience has not yet been examined. Our objective was to examine and compare the impact of individual characteristics, external factors and coping strategies on nurses' resilience. A descriptive cross-sectional study was conducted. Data were collected from 1,012 Greek nurses working in eight hospitals in northern Greece. Resilience, anxiety and depression, were measured using existing validated self- report instruments. In terms of coping strategies, this study used the "Mental Preparation Strategies Scale" to assess the mental preparation strategies employed by nurses before the beginning of their shift. Educational level, anxiety and the overall use of mental preparation strategies were the main predictors of nurse's resilience ([F = 52.781, p = 0.000, R2 = 0.139, Adjusted R2 = 0.137]). Resilient nurses were better educated {(b = 0.094. 95% confidence interval [CI] 0.038, 0.162)}, had lower anxiety ([b = -0.449, 95% CI -0.526, -0.372]) and used more often mental preparation strategies before the beginning of their shift ([b = 0.101, 95% CI 0.016, 0.061]). Findings provide information about which subgroups of nurses are more vulnerable in terms of resilience, i.e. less educated nurses, or nurses working in internal medicine wards.

Electronic nursing documentation interventions to promote or improve patient safety and quality care: A systematic review.

Abstract: Aim To review the evidence on the effects/impact of electronic nursing documentation interventions on promoting or improving quality care and/or patient safety in acute hospital settings. Background Electronic documentation has been recommended to improve quality care and patient safety. With the gradual move from paper-based to electronic nursing documentation internationally, there is a need to identify interventions that can effectively improve quality care and patient safety. Evaluation We conducted a systematic review on the effectiveness of electronic nursing documentation interventions on promoting or improving quality care and/or patient safety in acute hospital settings. Key issues Six articles reporting on six individual studies met all eligibility criteria. They were uncontrolled pre/post intervention studies reporting positive impacts on at least one or more outcomes. Most outcomes related to documentation practice and documentation of content. Conclusion Some evidence from our review indicates that implementing electronic nursing documentation in acute hospital settings is time saving, reduces rates of documentation errors, falls and infections. Implications for nursing management A planned approach from management over time to allow nurses adapt to new electronic systems of documentation would seem a good investment in terms of efficiency of work time, possibly resulting in more time for clinical care.

The mediating role of inclusive leadership: Work engagement and innovative behaviour among Chinese head nurses.

Abstract: AIM This study investigated the relationship between work engagement and inclusive leadership in Chinese hospital head nurses. Besides, it explored the effect of the mediating role of inclusive leadership in the relationship between work engagement and innovative behaviour among Chinese hospital head nurses. BACKGROUND Head nurses are essential in the group of registered nurses who are to pass the Chinese licensure examination for nurses. Their work engagement and innovative behaviour are beneficial to improve the quality, efficiency and competitiveness of nursing services. However, little is known about the mediating role of inclusive leadership in the relationship between work engagement and innovative behaviour. METHODS In April 2018, a total of 374 Chinese head nurses were surveyed with a Work Engagement Scale, an Inclusive Leadership Scale and an Innovative Behavior Scale. Because the data were normally distributed in our study, Pearson's correlation coefficient (r) was used to conduct the correlation analysis of study variables. Multiple linear regression analysis was used to explore the factors of innovative behaviour. Model 4 of Hayes's (2013) PROCESS macro and Bootstrap method was used to examine the mediating role of inclusive leadership. RESULT Inclusive leadership was significantly and positively correlated to innovative behaviour and work engagement (p < 0.01). Moreover, work engagement was correlated with innovative behaviour (p < 0.01). In addition, hospital level, publishing papers, work engagement and inclusive leadership were the factors of head nurses' innovative behaviour (p < 0.01). Inclusive leadership partially mediated the relationship between work engagement and innovative behaviour, accordingly. CONCLUSION Work engagement affects innovative behaviour among Chinese head nurses, and inclusive leadership is a mediator in the relationship. We should take measures to improve the leaders' level of inclusive leadership, in order to strengthen head nurses' innovative behaviour. IMPLICATIONS FOR NURSING MANAGEMENT According to the results of the study, the leaders of head nurses should pay attention to improve head nurses' innovative behaviour, inclusive leadership, work engagement, and the quality and competitiveness of nursing.

Violence towards Emergency Nurses: The 2016 Italian National Survey-A cross-sectional study.

Abstract: Aim To analyse the dimensions and characteristics of violence towards Emergency nurses in a national context (Italy). Background Nurses are the most exposed to workplace violence, especially in Emergency Department contexts. Methods A cross-sectional study was conducted in all Italian regions. Descriptive analyses were used to examine violence from patients and relatives (Type II violence) concerning personal characteristics of the Emergency nurses and perpetrators, environmental and organisational factors. Multinomial logistic regression analysis was used to investigate risk factors. Results About 76.0% of Emergency nurses experienced verbal violence, 15.5% both verbal and physical violence and only 8.5% denied having experienced either. Older age and more experience in Emergency settings are protective factors. Working in the South of Italy significantly increases the probability of being exposed. Discussion There are many factors explaining violence, but some correlations are not clear. Conclusion Factors that have a positive effect on this problem include: specific training for younger nurses, a strong alliance between users and health personnel to restore a relationship of trust between parties, physical barriers and appropriate architectural measures. Implications for nursing management Comprehensive approaches can represent an effective strategy to counteract workplace violence.

Pressure injuries in critical patients: Incidence, patient-associated factors, and nursing workload.

Abstract: AIM To estimate the incidence of pressure injury and its predictors including nursing workload in critical patients BACKGROUND There is controversy about the influence of the nursing workload on the occurrence of pressure injury in intensive care units METHODS A retrospective cohort of 766 patients in nine intensive care units of two university hospitals was studied The nursing workload was measured using the Nursing Activities Score The predictors were identified by logistic regression RESULTS The pressure injury incidence was 187% The odds ratio of the development of pressure injury, increased 35 times in mechanical ventilation (p < 0001), 78 times in palliative care (p = 0004), 23 times in the 60-84 years old group (p = 0005); it also increased 10% for each day of hospitalization (p < 0001), and 15% for each registered point of the Nursing Activities Score (p = 0016) CONCLUSION Existing risks for the development of pressure injury have been confirmed and nursing workload identified as a new predictor Much still needs to be done in the area of prevention, especially in groups at risk IMPLICATIONS FOR NURSING MANAGEMENT Increasing nursing resources in the intensive care unit may assist in reducing the pressure injury rate

Job burnout and quality of working life among Chinese nurses: A cross-sectional study.

Abstract: Aim To explore the relationship between job burnout and quality of working life, and identify influencing factors of nurses' quality of working life. Background Understanding the influencing factors of quality of working life is important to improve nursing retention strategies. Job burnout can negatively influence work efficiency and quality of work. However, studies examining the association between the two remain limited. Methods The cross-sectional survey of 2,504 nurses was performed in Eastern China. Nurses were invited to complete self-report questionnaires online. The collected data were analysed using Pearson's correlation and multiple regression. Results About 64.0% of nurses experienced job burnout, and their quality of working life was at a moderate level. Job burnout, hospital level, age, income, night shift and patient-to-nurse ratio were significant factors of quality of working life. Conclusion Job burnout has a negative effect on nurses' quality of working life. Some demographic and work-related factors should be considered when developing interventions to improve nurses' quality of working life. Implications for nursing management Hospital and nurses managers should develop strategies to reduce nurses' job burnout and enhance their quality of working life, such as optimum nurse staffing, offer reasonable pecuniary compensation and establish an appropriate shift work schedule.

Systematic review: Association between the patient–nurse ratio and nurse outcomes in acute care hospitals

Abstract: Aims: To evaluate and summarize current evidence on the relationship between the patient-nurse ratio staffing method and nurse employee outcomes. Background: Evidence-based decision-making linking nurse staffing with staff-related outcomes is a much needed research area. Although multiple studies have investigated this phenomenon, the evidence is mixed and fragmented. Evaluation: A systematic literature search was conducted using PubMed, Embase, Web of Science, Cinahl, Cochrane Library and the ERIC databases. Thirty studies were identified, analysing eight selected key nurse outcomes. Key issue(s): Future research should focus on unit-level data, incorporate other methodologies and aim for comparability between different types of clinical settings as well as different health care systems. Conclusion: A relationship between the patient-nurse ratio and specific staff-related outcomes is confirmed by various studies. However, apart from the patient-nurse ratio other variables have to be taken into consideration to ensure quality of care (e.g., skill mix, the work environment and patient acuity). Implications for Nursing Management: Hospital management should pursue the access and use of reliable data so that the validity and generalizability of evidence-based research can be assessed, which in turn can be converted into policy guidelines.

The mediating role of work alienation in the effect of workplace loneliness on nurses' performance.

Abstract: Aim The purpose of this study was to determine the mediating role that work alienation has in the effect of loneliness at the workplace on nurses' job performance. Background The literature includes no research on the relationship between nurses' workplace loneliness, work alienation and job performance. The study used work alienation as a mediating variable, which adds to the originality of the study. This study was carried out to contribute to relevant field research. Methods The study used a cross-sectional research design and surveyed 138 nurses working in a public hospital in Turkey. The data were analysed using descriptive statistical methods, Pearson correlation analysis and the PROCESS macro Model 4 in the regression analysis. Results Workplace loneliness has a negative effect on job performance. This negative effect is magnified when work alienation is used as a mediating variable. Conclusion Nurses' loneliness at the workplace and work alienation leads to a decline in their job performance. Implications for nursing management Nursing managers should take into consideration that nurses' feelings of workplace loneliness and alienation can reduce the nurses' job performance. When managers create formal and informal support networks, it can reduce nurses' negative feelings of loneliness and alienation. Thus, helping nurses to perform better at work.

Are long nursing shifts on hospital wards associated with sickness absence? A longitudinal retrospective observational study.

Abstract: OBJECTIVE To investigate whether working 12 hr shifts is associated with increased sickness absence among registered nurses and health care assistants. BACKGROUND Previous studies reported negative impacts on nurses' 12 hr shifts; however, these studies used cross-sectional techniques and subjective nurse-reported data. METHODS A retrospective longitudinal study using routinely collected data across 32 general inpatient wards at an acute hospital in England. We used generalized linear mixed models to explore the association between shift patterns and the subsequent occurrence of short (<7 days) or long-term (≥7 days) sickness absence. RESULTS We analysed 601,282 shifts and 8,090 distinct episodes of sickness absence. When more than 75% of shifts worked in the past 7 days were 12 hr in length, the odds of both a short-term (adjusted odds ratio = 1.28; 95% confidence index: 1.18-1.39) and long-term sickness episode (adjusted odds ratio = 1.22; 95% confidence index: 1.08-1.37) were increased compared with working none. CONCLUSION Working long shifts on hospital wards is associated with a higher risk of sickness absence for registered nurses and health care assistants. IMPLICATIONS FOR NURSING MANAGEMENT The higher sickness absence rates associated with long shifts could result in additional costs or loss of productivity for hospitals. The routine implementation of long shifts should be avoided.

Nurses' negative affective states, moral disengagement, and knowledge hiding: The moderating role of ethical leadership.

Abstract: Aim This study aims to investigate the influence of nurses' negative affective states on their knowledge-hiding behaviours through moral disengagement, and especially the moderating role of ethical leadership. Background Researchers have paid much attention to the harmfulness of knowledge hiding, yet the mechanisms of why and how nurses' negative affective states have an impact on their knowledge-hiding behaviours are less clear. Method Two different questionnaire surveys were used in two different studies. In Study 1, a research design with three stages, including 323 nurses (64.47% response rate, 51.70% male) working in a hospital in Shanghai, China, was used. Study 2 involved 317 nurses (63.40% response rate, 51.74% male) working in five hospitals in Shanghai, China. The two studies shared the same statistical method, in which hierarchical regression analyses, the Sobel test, and bootstrap estimates were used to test hypotheses. Results We found that (a) nurses' negative affective states were positively related to their knowledge-hiding behaviours; (b) moral disengagement partially mediated this relationship in Study 1, but fully mediated it in Study 2; and (c) ethical leadership mitigated the indirect relationship between negative affective states and knowledge hiding via moral disengagement. Conclusion Nurses with negative affective states are more likely to activate moral disengagement as a secondary cognitive process to make personal moral rules momentarily obscure, which, in turn, leads them to hide knowledge that is requested by other members. The above relationships will depend on the levels of ethical leadership. Implications for nursing management Nurse managers should try to reduce nurses' knowledge-hiding behaviours by addressing nurses' negative affective states, decreasing nurses' moral disengagement, and performing ethical leadership behaviours.

Work schedule characteristics and fatigue among rotating shift nurses in hospital setting: An integrative review.

Abstract: Aim To systematically evaluate the effect of work schedule characteristics on fatigue among shift nurses in hospital settings. Background The complexity and multidimensional nature of nursing work may lead to fatigue. This review mainly focused on work schedule characteristics that may mitigate the fatigue in nurses. Evaluation Six databases were searched, and eight relevant research articles published between 2000 and 2018 were identified. Key issues The reviewed articles provided evidence supporting the association of work schedule characteristics such as total working hours, overtime, shift length and number of monthly night and evening shifts with fatigue. In addition, studies provided evidence for the positive association between insufficient rest period between shifts and fatigue among shift nurses in hospital settings. Conclusion The reviewed studies provided mixed results regarding the associations between work schedule characteristics and nurse fatigue. However, quick returns and days called to work on days off were consistent factors contributing to nurse fatigue. More evidence is needed to arrive at a definitive conclusion about such relationships. Implication for nursing management Nursing managers and administrators need to carefully review current rotating shift system and examine its impact on nurse fatigue as well as ensure enough resting time when developing nurse schedules.

Authentic leadership, job satisfaction and organizational commitment: The moderating effect of nurse tenure.

Abstract: AIMS To examine the associations between unit managers' authentic leadership with job satisfaction and organizational commitment and to investigate whether nurse tenure has a moderating effect on these associations. BACKGROUND Authentic leaders create trusting relationships with their staff and help nurses become more satisfied with their jobs and committed to their organizations. Because nurses have different perceptions of their working environments based on their tenure, the effectiveness of managerial leadership differ accordingly. METHODS This study is a cross-sectional secondary analysis using survey data from 1,118 staff nurses. To determine the significant tenure range for the associations between authentic leadership, job satisfaction and organizational commitment, the Johnson-Neyman method was used. RESULTS Authentic managerial leadership perceived by staff nurses had positive associations with job satisfaction and organizational commitment. The strengths of these associations were attenuated with nurse tenure and were no longer significant for nurses with more than 20 years of tenure. CONCLUSIONS Although authentic leadership in managers was effective, the strengths of its effectiveness varied based on nurse tenure. IMPLICATIONS FOR NURSING MANAGEMENT According to nurse tenure, differentiated approaches are needed to increase the job satisfaction and organizational commitment of staff nurses.

Presenteeism: Nurse perceptions and consequences.

Abstract: Aims To describe factors leading to and consequences of nurse presenteeism. Background Presenteeism is more prevalent among nurses than other occupational groups. Existing literatures focuses on prevalence and consequences of presenteeism for patients, health care organizations, and nurses. However, we lack understanding of nurse perceptions of factors leading to and consequences of presenteeism. Methods A total of 295 free responses to a cross-sectional survey were analysed using conventional content analysis. Results Nurses consider multiple factors in deciding how to respond when presentee. These include illness, staffing, availability of leave time, patients, financial constraints and guilt. Consequences of presenteeism identified were decreased mental acuity and attitude leading to lessened communication both in-person and in documentation, transmission of illness, and decline in unit culture, patient care, and nurse health and well-being. Conclusions Multiple factors lead to nurse presenteeism and there are negative consequences to nurses' health, work environment and patient care outcomes. Implications for nursing management This study leads to key discoveries to the reasons for and consequences of nurse presenteeism. Many of the factors leading to presenteeism can be addressed through culture and policy changes within organizations. The consequences to patient care outcomes and the work environment emphasize the importance of addressing presenteeism.

Nurses and health-promoting self-care: Do we practice what we preach?

Abstract: Aims To examine the health-promoting behaviours performed by registered nurses (RNs), as well as workplace factors that influence participation in those behaviours. Background Nurses have high levels of overweight/obesity and may not be engaging in health-promoting self-care. Methods A cross-sectional Web-based survey collected information from 335 RNs regarding their physical activity, sedentariness and fruit/vegetable consumption. Results More than half were overweight (34.1%) or obese (23.4%), and 80.1% were "sedentary" (≥3 hr sitting/day), particularly those working outside of direct patient care in management, research and education. Only 47.2% consumed 5+ servings of fruits/vegetables daily. Nurses who enjoyed their jobs (higher levels of compassion satisfaction) reported higher levels of physical activity (p = 0.03) and fruit/vegetable consumption (p = 0.02). Conclusion RNs who work outside of direct patient care might be at increased risk for sedentariness and obesity. RNs who enjoy their jobs may experience less stress and have more energy to exercise and to prepare/consume healthy meals. Implications for nursing management Nurse managers should practice self-care by engaging in exercise, proper nutrition and demonstrating work-life balance, both to protect their own health and to serve as role models for RNs in direct patient care.

Predicting the effect of nurse-patient ratio on nurse workload and care quality using discrete event simulation.

Abstract: Aim A novel nurse-focused discrete event simulation modelling approach was tested to predict nurse workload and care quality. Background It can be challenging for hospital managers to quantify the impact of changing operational policy and technical design such as nurse-patient ratios on nurse workload and care quality. Planning tools are needed-discrete event simulation is a potential solution. Method Using discrete event simulation, a demonstrator "Simulated Care Delivery Unit" model was created to predict the effects of varying nurse-patient ratios. Modelling inputs included the following: patient care data (GRASP systems data), inpatient unit floor plan and operating logic. Model outputs included the following: nurse workload in terms of task-in-queue, cumulative distance walked and Care quality in terms of task in queue time, missed care. Results The model demonstrated that as NPR increases, care quality deteriorated (120% missed care; 20% task-in-queue time) and nursing workload increased (120% task-in-queue; 110% cumulative walking distance). Conclusions DES has the potential to be used to inform operational policy and technical design decisions, in terms of impacts on nurse workload and care quality. Implications for nursing management This research offers the ability to quantify the impacts of proposed policy changes and technical design decisions, and provide a more cost-effective and safe alternative to the current trial and error methodologies.

Humble leadership and innovative behaviour among Chinese nurses: The mediating role of work engagement.

Abstract: AIM This study aimed to investigate the effect of humble leadership on innovative behaviour among Chinese nurses and to examine the mediating role of work engagement in this relationship. BACKGROUND Nurses' innovative behaviour and work engagement are critical to the quality of health care services. Although research has established that leadership is beneficial for individuals, teams and organisations, it's less clear whether humble leadership could promote innovative behaviour and work engagement among nurses. METHODS The data were collected in China. A sample of 377 nurses completed measures of humble leadership, innovative behaviour and the Utrecht Work Engagement Scale. Structural equation model was adopted to verify the research hypotheses. RESULTS Humble leadership was significantly and positively related to nurses' innovative behaviour and work engagement (p < .01). And work engagement partially mediated the association between humble leadership and innovative behaviour. CONCLUSION Humble leaders are critical to enhancing nurses' innovative behaviour, and work engagement plays an intervening mechanism explaining how humble leaders promote innovative behaviour among nurses. IMPLICATIONS FOR NURSING MANAGEMENT Hospital managers should pay attention to improve head nurses' humble leadership, which could lead to a higher level of innovative behaviour and work engagement among nurse.

Meaning in life and self-esteem help hospice nurses withstand prolonged exposure to death.

Abstract: Aim The purpose of this study was to investigate relationships between the presence of and search for meaning in life and self-esteem, psychological distress, burnout and affect among hospice nurses. Background The nature of hospice nursing may prompt existential concerns. Method Hospice nurses (N = 90) completed an online survey. Results The presence of meaning in life was associated with lower psychological distress, burnout and negative affect, and higher levels of positive affect, whereas the search for meaning in life was only associated with higher negative affect. Self-esteem mediated the relationship between the presence of meaning in life and psychological distress, burnout and negative affect. Conclusion The presence of meaning in life promotes self-esteem, which then buffers against negative outcomes. Implication for nursing management Although managers cannot directly instil meaning in life in hospice nurses, they may be able to help nurses to find or maintain meaning by promoting policies that allow them to participate in meaningful personal, cultural or religious activities. Additionally, managers of hospice nurses could connect them with resources (e.g. mentors, counsellors or chaplains) to cope with the existential demands of providing end-of-life care.

A structural model of total quality management, work values, job satisfaction and patient-safety-culture attitude among nurses.

Abstract: Aim This study explores the impact of total quality management on patient-safety-culture attitudes among clinical nurses, focusing on the correlations between total quality management, work values, employee satisfaction, and patient-safety-culture attitudes. Background Implementing total quality management can improve nurses' attitudes towards patient-safety culture. Method This hospital-based, cross-sectional survey used a convenience sample of 30 inpatient units and 12 intensive care units at five Taiwanese regional teaching hospitals with over 500 beds. Seven hundred questionnaires were distributed (140 to each hospital) during 25 June-5 July 2015. Data were collected using an anonymous, self-administered, and structured questionnaire. The model was tested using structural equation modelling and serial mediation analysis. Results Of 515 completed questionnaires (73.6% response rate), 23 were invalid and 492 were used (70.3% retrieved rate). The total effect of total quality management on patient-safety-culture attitudes was significant via work values, which had a direct influence on patient-safety-culture attitude. Total quality management affected employee satisfaction, which directly influenced patient-safety-culture attitudes. Conclusion Total quality management creates a beneficial working environment and improves patient-safety culture. Total quality management, work values, and employee satisfaction orientation are important predictors of nurses' attitudes toward patient-safety-culture attitudes. Implications for nursing management Health care managers should cultivate nursing performance to achieve continuous quality improvement in nursing care.

How do career barriers and supports impact nurse professional commitment and professional turnover intention

Abstract: Aims This study examines how career barriers and supports (i.e., perceived discrimination, lack of advancement, human capital, and social capital) impact affective, normative, and continuance aspects of professional commitment and thus nurses' professional turnover intention. Background Professional commitment is known to influence professional turnover intention. However, little is known about how career barriers and supports contribute to professional commitment and reduce professional turnover intention. Methods This study adopted a cross-sectional design and a survey to collect representative data in a major hospital in northern Taiwan. We used proportionate random sampling to ensure sample representativeness and obtained 524 responses. Results Perceived discrimination and lack of advancement were negatively related to affective professional commitment. Human capital was positively related to affective, normative, and continuance professional commitment. Social capital was positively related to normative professional commitment. All aspects of professional commitment were negatively related to professional turnover intention. Conclusion Career barriers and supports have an important influence on professional commitment. Reduced barriers and enhanced support may therefore help reduce nurses' professional turnover intentions. Implications for nursing management Nursing managers could aim to lessen career barriers while increasing career support for nurses, helping strengthen nurses' professional commitment and retention.

Resilience in nurses in terms of perceived social support, job satisfaction and certain variables.

Abstract: AIM This study investigated the resilience of nurses, the factors that contribute to resilience, and its relationship with perceptions of social support and job satisfaction. BACKGROUND Resilience plays an important role in how nurses cope with work-related stressors. METHODS A descriptive study was conducted with 242 nurses working at three public hospitals in Turkey. Data were collected using a descriptive data form, the Resilience Scale for Adults (RSA), the Multidimensional Scale of Perceived Social Support (MSPSS) and the Minnesota Job Satisfaction Scale (MJSS). RESULTS Nurses' mean scores on the RSA, MSPSS, and MJSS were 99.80 ± 4.43, 66.66 ± 13.30, and 3.31 ± 0.72, respectively. Statistically significant relationships were detected between resilience and five factors: age, gender, mother's educational level, work experience and working hours (p < 0.05). A statistically significant positive correlation was also observed between MJSS score and both total RSA and family support subscale scores (p < 0.05). CONCLUSION The resilience, perceived social support, and job satisfaction of participating nurses were moderate. Significant factors in their resilience were age, gender, mother's educational level, work experience, working hours, perceived social support and job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers can use the results to plan interventions that improve resilience among nurses.

Registered nurses' perspectives of work satisfaction, patient safety and intention to stay - A double-edged sword.

Abstract: AimTo describe job satisfaction in registered nurses (RNs), their intention to stay at their current workplace and in the profession and to explore patient safety in relation to these.BackgroundNur ...

Safety culture in health care teams: A narrative review of the literature.

Abstract: Aim Explore the recent literature to examine the factors that affect safety culture within health care teams. Background Health care organisations must understand and improve their safety culture. However, safety culture is a complex phenomenon which interacts with a myriad of factors, making it difficult to define, measure and improve. Evaluation A comprehensive search strategy was used to search four major databases. Peer-reviewed which were published in English between 2006 and 2017 and presented research studies related to safety culture in health care teams were included. A narrative analysis was undertaken. Key issues Issues relevant to the definition, measurement and improvement of safety culture, the impact of teamwork and communication on safety culture, the role of leaders and accountability are explored. Conclusion The above themes inform our understanding of developing, measuring and sustaining safety culture in health care teams. However, further research is warranted to accurately understand how to measure and improve safety culture. Implications for nursing management To support a safety culture, initiatives to facilitate effective communication between nurse practitioners and other health care professionals must be introduced. Nurse managers should adopt leadership strategies that will support nurses' psychological safety and create a just culture.